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2

Establish Goals of Therapy

Case• 74 year old male, T2D x 20 years• A1c had been 7.2%, recently 9.0%• Glyburide, metformin- doses recently increased to 20 mg glyburide

and 1000 mg bid• More forgetful and disoriented recently• Blurry vision, nocturia• PMH HTN, HLD• No SMBG• PE remarkable for older than stated age, oriented to person and

place only, BMI 27.4, BP 165/95, absent pedal pulses and monofilament sensation

• eGFR 36 ml/min/1.73m2, urine alb/Cr 279 mg/g

What would be your target HbA1c for this patient ?

• A. Less than 9% and ≥8.5%• B. Less than 8.5%• C. Less than 8.0% and ≥7.5%• D. Less than 7.5%

Page 8

Which Target??

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Older Adult with Diabetes

Medical Complications

Cognitive Function

Geriatric Syndromes

PhysicalFunction

Pharmacologic Considerations

Individualize Targets and Strategies

Standard InterventionsHypoglycemia Prevention Telemedicine

MonitorSupport Educate

Functional Medicine

Engage Family & Social Resources